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New Here - Could use some help - Printable Version

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New Here - Could use some help - tsitalon1 - 01-21-2021

Just diagnosed with "Severe Sleep Apnea" after a home sleep study.

System - Dreamstation
Mask - Dreamwear Nasal
Humidifier

I understand it's not best to leave the machine on Auto 5/20, but my doctor asked that I leave it on Auto for a month as they monitor... This is only my second night, and while I'm still trying to adjust to life with a hose attached to me during sleep, I'm not feeling much better and Oscar is still reporting significant amounts of AHI.

Below are my first two nights results, as you can see I dropped my AHI from ~ 18 to 11, the only "change" I made was changing the flex setting from 2 to 3 and increasing humidty from 3 to 4.  I really find it difficult sleeping with higher pressures (13-17).  I hope I won't need that amount in the future. 

Also, if I'm reading my leakage data properly, looks like I'm ok to continue using the Nasal mask, I was worried as I'm a mouth breather, but data suggests the nasal mask is fine.

Thoughts / Ideas?


RE: New Here - Could use some help - staceyburke - 01-21-2021

I’m sure you will get several posts on this but here goes. Your main events are centrals and the machine you are using can NOT stop them. But using EPR can cause them to happen more often. I would turn it off not increase it.

Second there are some clustered H and OA which suggests you have some positional apnea. No machine can help these! You are cutting off your airway by tucking you chin. Many people do this and have found help with a collar (link at the bottom of this post). It can also be helpful to stop sleeping on your back and reducing the size of your pillow to stop chin tucking.


RE: New Here - Could use some help - Sleeprider - 01-21-2021

First turn off ramp. It is starting at a pressure of 4 and goes for 30 minutes of ineffective therapy. You could probably use the 5-20 pressure on a Resmed Autoset, but no Philips. It is far too slow to reach optimum pressure and is reacting to events rather than preventing them. It's no mystery to you that AHI form 11 to 20 per hour is not effective therapy. Increase the minimum pressure to 8.0. If you feel you need permission, just call the doctor's office and tell him the low pressure doesn't work. 8.0 is a minimal effective pressure for many people, and I don't think it is your final pressure.

Your leaks are in great shape, and not a problem. I generally find that Flex set to 2 is better than 3 for respiration sync. Feel free to experiment, and between your two charts, the one at AFlex 3 has lower AHI. I prefer manual settings for humidity. It delivers more moisture, and works better as long as you don't overshoot and have condensation. You clearly need higher pressure, and 8.0 is at least a starting point. Too bad you didn't get the Resmed Airsense 10 Autoset. Much more comfortable and effective machine.

Regarding centrals, it's too soon to judge. Your focus needs to be on resolving obstructive events, and usually centrals will also decline. If not, we will be talking about a different therapy option.


RE: New Here - Could use some help - tsitalon1 - 01-21-2021

Roger that, I won't use ramp, changed Humidification to fixed/4 and I've changed my Min pressure to 8, guess I'll stick with Flex of 3. The heck with my provider, they'll get over it Smile

I should of asked which machine is better, but too late to cry over it, I do like the Dreamwear nasal mask, it's probably as comfortable as masks get.

I'll post my next two nights here for review.

I really appreciate the quick feedback and help!


RE: New Here - Could use some help - mesenteria - 01-21-2021

It is a best practice to make initial changes that make sense, and then to do as little fiddling as possible for several nights in succession.  If your results continue to show improvement, you continue to improve your sleep quality, and that change will result in other changes which MAY need further adjustments.  But, changing too many things too often is almost always counterproductive.  So, my point is to keep reading and being open-minded, but don't expect miracles inside of your first week.  Expect further changes, but at a slower pace.  Stay open to new findings and new ideas.

You're doing very well so far.  Well-done


RE: New Here - Could use some help - SarcasticDave94 - 01-22-2021

Welcome to the bizarre world of Apnea, where docs don't want us to self advocate but are too lazy and incompetent to do it themselves.

Good advisements already. And good decision to mentally prepare in telling doc to stuff it. Coffee


RE: New Here - Could use some help - Gideon - 01-22-2021

Good advice above.
Would you perform a practical experiment please.

Get a tall glass of water and a straw.
Simply place the straw near the bottom and make like a kid and blow bubbles.


Any issues? You did do this, didn't you?

Didn't think so.

Now, assuming 8 inches of water, you just experienced the maximum pressure your CPAP is capable of producing, 20 cmw.

The point is that a CPAP, in any of it's forms is really a very low pressure device, even at its highest pressure.

Our goal is always to see that the optimal pressure for you is achieved. For me, I'm not comfortable unless the pressure is over 10, but that is me, not you, and we are all different.

You asked so the CPAP we prefer is the ResMed AirSense 10 AutoSet or the AutoSet for Her.


RE: New Here - Could use some help - tsitalon1 - 01-22-2021

Update:

I  guess my humidity setting was too aggressive for fixed humidity, I woke up in the middle of the night with my tube/mask sounding like a snorkel with water in it, so obviously I had to get up and empty my tube/mask, then I set the humidity down to one.

AHI dropped to 7.82 with these changes, shall I up the min again?


Yep, live and learn.  If need be, I'll buy the Resmed direct through an online retailer, but I see no reason why we can't get the Dreamstation to work for me, do you?


RE: New Here - Could use some help - SarcasticDave94 - 01-22-2021

Me, I'd consider taking minimum up to 8.5-9 to combat Hypopneas and dropping flex to 2. Most users of flex report that 2 is better than 3. Myself sees the Philips rough road pattern of treatment IMO, so to me Philips treatment just looks crude and less comfortable. The OSCAR chart just looks rough to take vs what ResMed would give. If you do go to PAP market for ResMed, take a look at Supplier #2.

On the water in the hose, do you have a heated hose? If yes turn up the heated setting. And if this rainout occurs again, you should just be able to drain it back into the humidifier.


RE: New Here - Could use some help - Sleeprider - 01-22-2021

I see no harm in moving the minimum to 9.0, and that increase is consistent with titration protocols for the obstruction.

Sorry about the condensation. A couple tricks. If you don't used a heated tube, request or buy one. They really are not that expensive at $20 on Amazon for the HT15 Heated Tubing. To make it even more comfortable, soft and to resist condensation consider a fleece cpap tube cover. I use the Snuggle Skins CPAP Tube cover which is long enough to also fit over my mask tube, at about $21. They last forever and are a good investment in comfort. Finally, be sure your tube is routed upward from the outlet of the CPAP before dropping back to where you sleep. I suspend my by a lanyard to the headboard. This will allow water to drain back to the humidifier, and allow you to move easier in bed.